KED extrication device for trauma extraction: what it is and how to use it
In emergency medicine, the Kendrick Extrication Device (KED) is a first aid device used to extract a traumatised person from a vehicle in the event of a road accident
The KED surrounds
- the head;
- the neck;
- the trunk.
Thanks to the KED, these three segments are locked in a semi-rigid position, allowing the spinal column to be immobilised.
The Kendrick extrication device is always applied after the application of the cervical collar: the latter is very important to maintain the immobilisation of the head-neck-trunk axis, to avoid even very serious and irreversible damage to the nervous system during the extraction of the injured person from the vehicle, such as paralysis of the upper and lower limbs or death.
How the KED is made
Unlike a long spinal board or litter, a Kendrick extrication device consists of a series of bars made of wood or other rigid material covered with a nylon jacket, which is placed behind the head, neck and trunk of the subject.
A KED is usually characterised by:
- two hook-and-loop straps for the head;
- three adjustable attachments for the trunk (with different colours to be attached to the right belt);
- two loops that are attached to the legs.
These straps allow the subject to be secured to wooden bars or other rigid material.
Advantages of the KED
The Kendrick extrication device has many advantages:
- it is economical;
- it is easy to use;
- it can be put on quickly;
- it has coloured straps that make it easier for the rescuer;
- can be quickly and easily inserted into the seat of a vehicle by a single rescuer;
- allows access to the airway;
- prevents even very serious and irreversible damage;
- adapts to any body size.
KED in children and infants
Although the Kendrick extrication device can also be used to immobilise infants and children, it is obviously preferable to use specially designed paediatric immobilisation devices whenever possible.
If the KED is used to immobilise an infant or child, adequate padding should be used to ensure complete immobilisation in a manner that does not cover the chest and abdomen of the young patient, thereby preventing continuous assessment of these vital areas.
When to use the KED
The device is used in patients who have to be extracted from vehicles, in order to avoid orthopaedic-neurological injuries, mainly to the spinal column and thus the spinal cord.
Before applying the KED
Before applying the KED, if possible, all the procedures preceding this phase should be completed, therefore:
- Safety and self-protection checks,
- Scene control
- vehicle security check;
- the safety position of the vehicle, which must be correctly signalled to approaching vehicles, with the engine off and the parking brake applied;
- checking the patient’s vital parameters, which must be stable;
- checking for any other more serious passengers;
- Checking for removal of any potential obstruction such as the steering column.
The ABC rule is more ‘important’ than the extrication device: in the event of a road accident with an injured person in the vehicle, the first thing to do is to check for airway patency, breathing and circulation and only then can the casualty be fitted with a neck brace and KED (unless the situation requires rapid extraction, e.g. if there are no intense flames in the vehicle).
How to apply the KED
The following are the main steps for using the Kendrick extrication device to extract a casualty from a vehicle:
- Place a cervical collar of the correct size on the neck of the casualty BEFORE applying the KED;
- The person is slowly slid forward, allowing the folded KED to be introduced behind the back (the KED is then placed between the back of the casualty and the back of the vehicle);
- The sides of the KED are unfolded under the armpits;
- The straps securing the KED are attached in a specific order:
- first the middle straps,
- then those at the bottom,
- followed by the leg and head straps,
- lastly, the upper straps (which can be annoying when breathing),
- the area that remains empty between the head and the KED is filled with pads of adequate volume to minimise movement of the cervical spine;
- the patient can be removed from the vehicle, rotated and secured on a spine board.
IMPORTANT There are debates and controversies about the exact order of application of the brace straps, with some arguing that the order does not matter, as long as the brace is secured in front of the head.
Care must be taken with the head pad, which can bring the head too far forward to allow the side panels to fully restrain it.
Care must be taken to secure the head correctly to maintain neutral immobilisation.
If the head is too far forward, the head is brought back to meet the KED unless there is pain or resistance.
If these symptoms are present, the head is immobilised in the position found.
Belts are characteristically coloured to help the rescuer remember the sequence and not to confuse the various attacks during the excitement of the moment:
- green for belts on the upper trunk;
- yellow or orange for those of the middle trunk;
- red for those on the lower torso;
- black for those on the legs.
Removing the KED
If the KED is a recent radiolucent model, the KED can be kept in place by placing the patient on the spine board; otherwise the “classic” KED should be removed as soon as the patient is placed on the spine board.
Rapid extrication: when the KED is not used
In most cases it is preferable to use the KED, but there are some situations in which the patient needs rapid extrication, in which case he/she may not be restrained by a KED and instead be taken directly out of the car, without losing time in applying the KED.
Reasons for using this technique include:
- the scene is unsafe for the casualty and/or rescuers;
- the patient’s condition is unstable and resuscitation maneuvers should be initiated as soon as possible;
- the patient is blocking access to another visibly more serious victim.
In simple terms, under normal conditions the KED should always be used, except in those cases where its use could lead to a more serious situation for the patient or other casualties.
For example, if a car is on fire and could explode at any time, the patient may be pulled from the vehicle without a KED, because its use could result in a loss of time that could be fatal to him or the rescuer.
IMPORTANT The KED is generally only used on haemodynamically stable victims; unstable victims are destroyed using rapid extrication techniques without the prior application of the KED.